Organization
FORT WORTH VASCULAR SPECIALISTS CORP
Active
Organization
FORT WORTH VASCULAR SPECIALISTS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YURY GAMPEL (MANAGER)
(818) 880-8605
Entity
Organization
Contact information
Practice address
5750 STRATUM DR, FORT WORTH, TX 76137-2757
(817) 989-2580
(817) 989-6555
Mailing address
26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
(818) 880-8605
(818) 579-7916
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
2471V0106X
Vascular-Interventional Technology Radiologic Technologist
—
—
Other
Enumeration date
03/10/2020
Last updated
06/05/2020
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